TOTAL RENAL CARE INC NPI 1962946350

NPI Information

NPI: 1962946350
Provider Name: TOTAL RENAL CARE INC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: TARA BOULEVARD DIALYSIS
CLIA Number: 11D2124236
Address: 6540 TARA BLVD
STE 200
JONESBORO, GA
ZIP 30236
Phone: (770) 968-8279

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NPI Details

TOTAL RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Jonesboro, GA. TOTAL RENAL CARE INC NPI is 1962946350. The provider is registered as an organization entity type.
The provider Is Doing Business As Tara Boulevard Dialysis.

The provider's business location address is:

6540 TARA BLVD
STE 200
JONESBORO, GA
ZIP 30236-228
Phone: (770) 968-8279
Fax: (770) 968-8744

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 11D2124236 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/5/2016 and was last updated on 2/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment		GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003190972A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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